Interventions for Ethnically Diverse Populations

1. Interventions for Ethnically Diverse Populations Chapter 7

2. Physical Activity Levels • Ethnic diverse populations have the highest rates of inactivity in the United States (CDC, 2005) • Sedentary behavior was (Crespo, 2000): • 52% in African Americans • 54% in Hispanics • 46% in American Indians/Alaska Native, and • 42% in Asian American/Pacific Islanders • Ethnic diverse population have: • Higher rates of heart disease • Higher rates of obesity • Higher rates of diabetes • Higher rates of chronic diseases such as Asthma • Higher rates of cancer

3. Physical Activity Promotion Programs for Ethnic Population • Few programs exist that target ethnic populations • Few studies have been conducted about • Barriers • Behavioral modification (interventions) • Limited research results in fewer strategies to ensure successful implementation of physical activity and exercise programs for this population

4. Social-economic Status • Many ethnic population come from low socieconomic status • They are uninsured or under insured • They are less likely • to have club memberships, • afford personal training, • access to safe neighborhoods to walk, • and less access to professional health professionals.

5. Factors related to Successful Physical Activity Interventions • The number one key factor in designing and promoting successful physical activity and exercise programs for ethnically diverse populations is cultural relevancy • Each ethnic groups has it: • Own norms • Own values • Own practices • Exercise leaders must consider these characteristics when promoting physical activity and exercise.

6. Factors related to Successful Physical Activity Interventions • Due to prevalence of obesity, diabetes, cardiovascular disease and other chronic diseases related to inactivity, implementation of physical activity and exercise interventions must account for these conditions. • Exercise leader needs to be have the knowledge about exercise prescription in people who possess these risks and chronic diseases. • Due to many of them fall in the low-income group, occupational and home-based programs may be more successful than traditional PA or exercise training programs.

7. Strategies for enhancing cultural relevancy are: • Recruitment & retention • Location of the intervention • Delivery of the intervention

8. Recruitment & Retention • PFT or health professionals must earn credibility in the ethnic community. • When participants have respect for the PFT than there is higher adherence rates (Yancey, Miles, and Jordan, 1999). • Successful interventions usually are supported by community leaders and religious agents (e.g. church or spiritual leader). • Community and religious leaders involved in leading the interventions results in higher adherence. • Successful story telling or report from a member of the ethnic group about the PA intervention results in higher adherence. • Ethnic mediated interventions & publications • Needs to be in both English ad language of the ethnic group • Media advisement should be language sensitive • Incentives to exercise need to be appropriate. • Free health screening • Money for participating

9. Mode of Delivery • Physical activity programs should have collaboration (partnerships) among variety of community based agencies • County health departments, universities, hospitals, churches, etc. • Community personal need to included in all phases of the program (design, implementation, evaluation, & interpretation) • Personnel involved • Trusted • Respected • Trained to work with ethnic groups • Culturally appropriate • Language • Appeal to the ethnic group • Family oriented • E.g., day care centers

10. Location of Intervention • Churches have been used to implement a number of PA programs in minority of communities. • Church base interventions increases PA in ethnically diverse populations: • Walking • Aerobics • Sports • Occupational and home-based programs are sites that can reach this population group.

11. Barriers to Physical Activity and/or Exercise • Barriers to physical activity and exercise within various ethnic populations must be careful considered when establishing specific interventions to increase both cultural relevancy and physical activity/exercise • Evidence suggest that the major barriers to PA/exercise in Hispanic and African Americans are consistent with those of Caucasians. These are: • Lack of time, • Motivation, • Social support, • Knowledge, • Health information, • Transportation, and • Safety. (Eyler et al., 1998; Jarbe et al., 2002) • But some are reported more frequently by Hispanics and African American • Hispanic groups report “lack of time” where as African Americans report “lack of safe places to be active” more frequently.

12. Consideration for Working with Other Diverse Populations • American Indians/Alaska Native • Little is known about effective PA Interventions • Limited access to health care and high diabetes • Family unit and spirituality are key to cultural relevancy. • Focus should be on the whole family to be active. • PA programs should foster a higher level of spirituality and community cohesion. • Asian Americans/Pacific Islanders • Little is known • High levels of obesity & heart disease • Programs need to be developed for cultural relevancy in this group. • There attitudes for PA are similar to other population groups. They do value PA in lower obesity and heart disease.

13. Successful Interventions • Project walk • impACT • LaVidaCaminando

14. Project Walk • Home based media campaign involving phone and emails to promote walking in ethnic minority women. • They are recruited via presentations at WIC meetings (women infants and children). • They are then provided staged-matched media materials (fliers, publications, newspaper, etc). • Presenters are bilingual. • Phoning is a form retentions. • Results increased time in walking.

15. impACT • ImPACT (increased motivation for physical activity) • Targest low ethnic minority women. • Designed to motivate women to become PA active. • Health educators are matched with clients and given guidance in how to exercise or become involved in PA. • They receive media stage based printed materials about PA with follow phone calls over a 10 month period. • Programs used culturally tailored education skills to increase PA.

16. La Vida Caminando • Designed by and for Latino families in rural cities of California. • Designed to promote CDC standards of PA. Example of commuinity collaboration by adding one PA facility in each of the 4 designated California communities, involve at least 200 adults in walking clubs, and organize community based activities and events. • Local advisory committee were formed to determine their PA goals (e.g., diabetes). • PA programs were low cost, low impact, and family friendly. • Media materials were in both Spanish and English. • Once one became a member of walking club face to face interventions were provided. • Results showed a increase in PA activity in the participants and decrease in the barriers to exercise.

17. Key Factors • Earn credibility with community and religious leaders • Build collaborations within the community • Media and printed materials should be culturally relevant • Use roles models to recruit for and deliver the intervention • Offer culturally relevant incentives • Offer programs in churches and community centers • Include the family • Provide day care for parents when ever possible

18. The End